21626 97TH AVE W.PDF9535
21626 97TH AVE W
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CA FILE NO.
Ctitical Areas Checklist
sitj6l�ilc�" (soils/topography/hy.drology/vegetation)
cation
L
�,�,Account Number:
3. Approximate Site Size (acres or square fea): 130 Y- (S5
4. Is this site currently developed7 V yes; no.
If yes; how is site developed?
' "'J V
.5. Describe the general site topography. Check all that apply.
k,,� Flat-. less than 5-feet elevation change over entire site.
Rolling: slopes on site generally less than 15% (a vertical rise of 10-feet over a
horizontal distance of 66-feet).
Hilly: slopes present on site of more than 15% and less than 30% ( a vertical rise
of 10-feet over a horizontal distance of 33 to 66-feet).
Steep: grades of greater than 30% present on site (a vertical rise of 10-feet over a
horizontal distance of less than 33-feet).
Other (please describe):
6. Site contains areas of year-round standing water: A42 Approx. Depth:
7. Site contains areas of seasonal standing water 1116 Approx. Depth:
What season(s) of the year?
8. Site is in the floodway Alej floodplain of a water course.
9. site contains a creek or an area where water flows across the grounds surface? Flows are year-
round? Flows are seasonal? (What time of year?
10. Site is primarily: forested meadow shrubs mixed
urban landscaped oawn,sh-.ubs etc)
11. Obvious wetland is present on site:
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.'COMM* SWCES
UNITY
090-199-
City of Edmonds
Critical Area&,Checklist--.
Vie Critical Areas Checklist contained on - ",,"'and -submit it -
to ih�'City. `Mi�City will -
this form is to be filled out by any person:,.,.,, , �;. ", ,
.. review -the checklist, make-a� precursory site
preparing a Development Permit visit, and make -a determination of the
Application for the City of Edmonds prior subsequent steps necessary to complete a
to his/her submittal of a development Aevelopment permit application.
permit to the City.
T'he purpose of the Checklist is to enable
City staff to determine whether any
potential Critical Areas are or may be
present on the subject property. The
information needed to complete the
Checklist should be easily available from
observations of the site or data available at
City Hall (Critical Areas inventories, maps,
or soil surveys).
An applicant, or histher representative,
must fill out the checklist, sign and date it,
With 'a signed copy of this form, the
applicant should alsosubmit a vicinity map
or plot plan for individual lots of the parcel
with enough detail that City staff can find
and identify the subject parcel(s). in -
addition, the applicant shall include
other pertinent infonmation (e.g. site
plan, topography map, etc.) or shidies in
conjunction With this Checklist to assist
staff in completing their prelimma
. ry..
assessment of the site.
I have completed the attached Critical Area Checklist and attest that the answers provided are
factual, to the best of my knowledge (fill out the appropriate column below).
Owner Applicant:
le. a - /:- - -
Name
016 Z6
Street Address
City, State, ZIP Phone
'11A 0,
Date
Applicant Representative:
Name
Street Address
City, State, ZIP Phone
signature
Date
C
V
STREET FILE
pECEIVED
AP R 9 1979
WASHINGTON NATURAL GAS COMPANY Dir. of Public Works
815 Mercer Street (P.O. Box 1869) Seattle, Washington 98111 Telephone (206) 622-6767
MR. LEIF LARSON
CITY ENGINEER
505 BELL STREET
EDMONDS, WASHINGTON 98020
Gentlemen:
Washington Natural Gas Company hereby applies for permission to:
Permission is requested to Install 2" Plastic Main in 97 Place West from
14' North of the centerline to 131' South of the centerline of 216 Place
S.W. (Pine Street) also
Install 5/8" Plastic Service to 21626 97 Avenue West
Per Attached Drawing: 793103
Construction is scheduled to begin April 1979 and will require
approximately 90 days to complete. If this work meets -with your approval, please sign
and return the original of this form.
Application Date April 5. 1979
EDMONDS PERMIT
WASHINGTON NATURAL GAS COMPANY
Douglas V. Damm
Operations Supervisor
WASHINGTON NATURAL GAS COMPANY is hereby authorized to perform the work listed above in ac-
cordance with their franchise and subject to all applicable state, county, and/or municipal ordinances and
specifitations. ;Z�� 9
Approval Date
WNG 566.1 (7/78)
2 1 i 4- E -Fl r F.
CITY OF EDMONDS
PUBLICIORKS DEPARTMENT, ENGINEERIIODIVISION
APPLICATION FOS RIGHT-OF-WAY CONSTRUCTION PE
THIS PERMIT MUST BE AVAILABLE AT THE JOB SITE FOR INSPECTION'PURPOSES
Applicant to Complete Parts A and B
A. Permit to be issued to: WASHINGTON NATURAL GAS COMPANY
For Work at:(address or vicinity) 21626 97 Avenue West
Type of Work to be done: Install 21' PE Main & 5/8" PE Service
(attach drawing when applicable)
Time Required -- Start:
Owner: WASHINGTON NATURAL GAS COMPANY
Name
P.O. Box 1869
Mailing Address
Seattle Wash. 98111
City State Zip
Contractor:
Name
Mailing Address
City
.Finish:-approx. 90 Days f rom date
Below
MA 2-6767 Ext. 256
Telephone Number
State License Number
t
State Zip Telephone Number
B.' INDEMNITY: Applicant understands and by his signature to this application, agrees
to hold the City of Edmonds harmless from any injuries, damages,.or claims of any
kind of description whatsoever, ioreseen or unforeseen, that may be made against
the applicant or the City of Edmonds, or any of its departments or employees,
including or not limited to the defense of any legal proceedings including defense
costs, court costs, and attorney fees by reason of granting this permit.
Upon issuance of this permit, the contractor is responsible for workmanship and
materials for a period of one year following the final inspection and acceptance
of the restoration by the Engineering Division.
Funds held from the Security Deposit (estimated restoration fee) will be held until
the final street patch is completed, at which time a debit or credit will be
processed for issuance to the applicant.
Work is subject to inspection and restoration in accordance with City*Code. A
C:.24-hour notice is required for inspection by Engineering. Call 775-25 25, ext. 220.
lab,lf-_ _I
--f-under-stand'that this permi t , he,job site.-t2o'r inspection
purposes at all times.
EDMONDS PERMIT Signature: Date:April 5, 1979
Owner or/Aggg'p
TO BE COMPLETED BY ISSUING AGENCY*
Date Issued: 9 — , 5; P e r m i t N o . _--4" 1-7 Fee: ItIle,
Security Bond: 11-1Z -
Time Authorized: 0
APPROVED BY
D a t e : �;;'
10-771v (Revised)
APPLICATION
The City of Edmonds,3TREET FLE for
SIDE SEWER PERNaT
NEW CONSTRUCTION 11 REPAIRS 0
109-06300
OWNER ............. Lemard ... j�cft.ia.N
ADDRESS ........ 2.1.6,26 .. �m ... 9.7th --- Ave...-.W
EASEMENT No . ..........................................
CONTRACTOR................. ................ I . .............. I ............................................... PERMIT No . ......................
LEGAL DESCRIPTION: LOT No - ---------------------------------------- ----- BLOCK No . ....................
NAME OF ADDITION ....
Dye Tested On Sewer 1972
Approved:
DATE� ...........
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